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I am the Executive Vice President of a prosthetic company.

We get patient referrals from doctors and then custom design prosthetics and orthotics, which are braces and artificial limbs. We are somewhat the middleman between the doctor and the patient. We custom design the device for each individual. After a person has suffered a trauma or a limb amputation, we facilitate their return to an everyday lifestyle by giving them state-of-the-art legs, arms, breasts, fingers, or toes.

Prosthetics are essentially replacement parts for people that have suffered either birth defects or traumas and disease that result in amputation. Orthotics, on the other hand, are brace supports for a weakened or deformed limb or joint. Back, neck, arm and leg orthosis are commonplace.

A thing that few people think about is the application of orthotics to footwear. There are tons of problems with people's backs, knees and necks due to their walking. We adjust and fabricate shoes and foot inserts to fix this. Diabetic foot problems especially require some sort of orthotic.

It is rare to see a person with an amputation on a day-to-day basis. In the media, however, the victims of battle wounds in the Iraq war show the importance of our field. The national media lets people see on TV the rehabilitation of these soldiers.

It varies between the short-term orthotic patients and the long-term prosthetic patients. Follow-up is one of the most important parts of prosthetic care because adjusting to a new limb isn't easy. It takes exact measurements, careful patient attention, and a good feel for the craft to make sure that their prosthetic device fits and works correctly. We like to think of them as life-long patients.

My dad had already been involved in the business for years and seeing the industry was inevitable. Luckily for me, I liked what I saw. The first time I really "dove in" was a summer I spent as a technician at a fabrication lab. That was the nitty-gritty of the business and I loved it. I was using plaster, wood, drill presses and constantly working with my hands. For me it was really fun just to make things.

There is a national test given by the American Board for Certification. People typically get certified in either prosthetics or orthotics. I would recommend both, but if it comes down to one or the other, prosthetics is the way to go. These days, a lot of different people are fitting orthotics, be it doctors, cast technicians, physical therapists or occupational therapists. The large supply of orthotics makes it harder to earn a living or find a job in that discipline. On the other hand, there are far fewer people that can perform prosthetic-related duties. This makes it an excellent area for young people to get involved.

There is definitely a salary spike associated with dual certification. Not only that, it gives you versatility and a better understanding of anatomy. There is a lot of overlapping information in the two areas that makes the leap easy.

It starts with a 200-300 question written test. After that, there is a three-day hands-on exam. They are tough, but if you prepare you are fine. It was a huge relief to pass and be done. I started moderately studying for an entire year before and really cracked down about three months before.

In this field, experience rules all. It's a little different than most industries. Grades are important, don't get me wrong, but when it comes to competition, those with the most experience win, no doubt. Practical experience, i.e. lab work at a prosthetic facility, not only shows schools that you know what to do, but that you can actually do it.

I think a minimum of a 3.0 would be expected in prosthetics/orthotics. If you had a little field experience and the 3.0, you would be prime for postgraduate work.

At first, there was the option of a four-year degree at the University of Washington that would make me eligible for the National Prosthetic and Orthotic Exam. Instead, I took the business degree path through the University of Iowa, followed by a post-grad program at Northwestern University; there was a six-month program in orthotics, followed by a six-month program in prosthetics. Once those were completed, I took a one-year internship in each discipline.

While getting my business degree from the University of Iowa, I had this prosthetist/orthotist path in mind. So to prepare, I took some ancillary courses like anatomy and started working in and around a prosthetic facility. I think the business degree helped me though; dealing and interacting with people is a skill I attribute to the degree.

You got to have the creative flair for this job. I have a new employee that was an engineer by education, but found that she was sick of sitting behind a computer and solving boring problems. Working with us, she seems much happier dealing with people and solving creative problems with creative solutions. We always say that the human body has no square corner or perfect edges. So when we make devices, there needs to be naturally smooth lines and flowing connections. To be a good prosthetist/orthotist, you need to have an artistic touch with all of your work.

Getting a residence assignment is the most difficult part. Despite years and years of education, it is still hard to get hired without any real world experience. You are dealing with expensive tools and products, not to mention the patient's lifestyle and rehabilitation. That and there are few sites. I would guess that there are less then one hundred places of employment, which makes it difficult for interns to get a position.

It is a very peculiar field because of the different roles you play. My day involves sales and marketing, technical creation of the devices, and psychological/emotional interaction with patients.

The typical day is broken down between very different areas. At one point, I actually see patients, which involves making technical adjustments, doing plaster/plastic fittings, taking impressions and fabrication. Another time, I could be attending a specialty clinic where physicians ask for our expertise in their office. Essentially, there is no "typical" day. As a healthcare and referral-style business, I have no idea what I have to do in a single day until I get to the office. Even then, it is up in the air. Paperwork does get in the way a lot though.

That is the real downside to doing what we do. We got into this industry to help people, and this hurdle gets thrown in the way. With insurance, government regulation, Medicare, Medicaid and the Veteran's Administration, there is just a ton of filing and organization that we have to take care of. It is for obvious reasons and protects the patient, but in my twenty-plus years in the field, I always wish that I could spend more time with patients and less time on their paperwork. But that's how healthcare works.

I find that patients are usually willing to work with me. My patients want to get full use of their bodies again, and are willing to work with me with full compliance. There is a negative side though: the money. Here in Iowa, a lot of our patients are geriatric and have no idea how their insurance coverage works. I wouldn't understand it if I weren't immersed in it. We have to help them out and sometimes it's hard to get funds or understanding from them. We try to walk them through what they can and can't afford, which is a shame, but that's part of the industry.

I always tell people that it takes at least five years before you've seen it all and know what to do. The real transition is from the books to the real application and this is when students and residents become employees. The classroom is a great place to learn, but it can't teach you the same things that experience teaches. Again, this is where working back in the lab on technical aspects can really teach real world situations.

We work very closely with surgeons and all sorts of doctors. They are our referral sources for patients. Be it by telephone or through meetings, we are part of a large circle of medical rehabilitation. Doctors, surgeons, therapists and hospitals are all involved. As prosthetists, we are the end of the line, in a good way, for these people towards their rehabilitation. About 90% of the time, the other physicians acknowledge that they don't know a lot about prosthetics/orthotics, and leave us to do what we think is best for the patients. It's kind of an open prescription.

We do a ton of work with physical therapists. While we are the end of the medical specialty field, therapists are the absolute last step before patients begin living a once-again normal lifestyle. We do only the basics with our patients. After basic usage and maintenance, we have little to do with our patient's full utilization of their device. We interact closely with therapists to ensure that each patient's device gets used to its fullest capacity.

We use an interface called CAD [computer aided design]. It's a computer program that lets us take exact measurements of patients and then design their limb in 3D on the computer. From there, we send the "sketch" out to a fabricator to design a limb that fits perfectly.

Well here is the good part. There is a huge supply and demand problem. There are roughly 3,000 people that work in prosthetics or orthotics in the United States. The demand, on the other hand, is high and increasing tenfold with baby-boomers and an aging population. It's a great field to get into for the individual looking to make great money in an interesting field where they are tremendously needed. Good salary, flexibility of hours, and fast promotions are all part of the field. We always tell people that if they like working with their hands and helping other people, this industry treats the individual very well.

Once a student completes his education, he will start on a "residency" at an actual prosthetic/orthotic company. It's really like any medical residency: it is about the experience, not the money. That aside, we still start our residents off at anywhere between the high $20,000's and the low $30,000's, depending on variables. This usually lasts a year until they receive their certification from the National Prosthetic and Orthotic Association. After that, the resident becomes an employee in the field, fitting patients and/or fabricating devices. At this point, they will typically see their salary rise to $40,000-$50,000. This is for newcomers that are schooled in either prosthetics or orthotics. A person that is disciplined in both fields and relatively few years of experience can easily see salaries of $60,000-$90,000 depending on their skill and performance. From an economic and financial perspective, it is an excellent line of work.

I like to look at things in five-year increments. This excludes the clinical residency, but after certification, major raises and promotions work within this time-scale. To reach the higher end of the pay-scale, I'd say ten years of experience is fairly normal with a certification in both prosthetics and orthotics.

Absolutely none, we love what we do, we get paid well doing it, and we have flexibility. I can only stress the pressure of paperwork and insurance companies. We are constantly lobbying for increased insurance spending on patients while the insurance companies, our main source of income, fight for less. People constantly complain about our healthcare system being broken, but from what I've seen, it's the best in the world. It just costs a lot.

On a day-to-day basis it comes down to the satisfaction of helping someone. On the prosthetist side, its amazing to have someone who has had their limb recently amputated for a disease or injury come into your office and have them walking again within days. It is so gratifying to give patients an ability we all take for granted.

This is not a cookie-cutter job. Every patient is different and every individual limb or brace fits one individual person. It's really cool to be able to help another person on a personal basis.

Yes - when I walk in at 7 a.m. and my cell phone is ringing off the hook with insurance problems or patients' problems, followed by all the extra things that we have to do the days can seem long. We get in the business for one-on-one care and hands-on fabrication. When you spend a day doing paperwork and arguing with financial institutions to pay for patients, you feel like it was wasted time. Jumping through hoops and blowing whistles make it a long day. Luckily, those days aren't the norm.

We deal with people. We are making a part of their bodies that they will use for the rest of their lives; interpersonal skills are vital to make this a success. I think interpersonal skills will go by the wayside for the younger generations as technology increases. This won't work and they'll quickly see this.

This is really another cool part of my job. I've dealt with some patients for over ten years and have formed really great relationships. You get involved in their lives and communities and find a ton of fun outside of work. I like to think of the "bad apple" principal. Most of our business comes through positive referrals. Even if I treat nine out of ten patients well, that tenth patient will never come back and make sure that the community knows. It is a repeat customer business and exceptional patient care is extremely important.

Technology is revolutionizing the industry. Because we are such a small industry, we end up stealing aspects of many different fields. The airplane, automobile and computer chip businesses have all helped us improve our product. We are using carbon-graphite and CAD design; not too long ago, blacksmiths were bending metals to produce makeshift prosthetics. Today, amputees are running, swimming, and participating in the Para-Olympics in every imaginable event. The trend to me is clearly the importance of technology.

That's a tough one. Experience opens doors, as with any field. You must get into a facility and watch and learn what to do. Get your hands wet and understand the craft if you're interested. One cool thing that I've recently seen is the change in education. Whereas it used to be required to do a six to eight month post-grad program, an online alternative is now available. The person can do a bulk of their course work online while getting involved in a prosthetic/orthotic company. This allows them to get a formal education while engaging in real-world learning, which is every bit as important. This leaves only about twenty percent of their course work to be completed, which they can finish in about four weeks at the actual school.

Again, I think those that do well are people that interact well with other people. This means patience, interpersonal skills and a desire to help. Those that get into this for the dollar will fail; those that genuinely like helping people do well. It is those that can stop and work hard to get gratified that really take-off.

Work hard early in your career. Don't get impatient with wages or hours: they will come eventually. Rewards come to those that work hard.

The average age of retirement is around 60-65, similar to any other line of work. Another cool aspect of prosthetic/orthotic work is that as long as you can interact well with people and use your hands, there is no "cut-off" age. As for the financial aspects, most people in our business find themselves very secure at the end of their career. Even if they aren't, or if they get bored in retirement, many older members do consultant or part-time jobs with sites around their area.